Overview
Bacterial meningitis is an infection of the meninges, typically caused by bacteria such as Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis, leading to inflammation and potential neurological complications 5.Diagnosis
Key Signs and Symptoms: Fever, headache, neck stiffness, altered mental status, and sometimes focal neurological deficits 4.
Diagnostic Tests: Lumbar puncture for cerebrospinal fluid (CSF) analysis, including cell count, glucose, protein levels, and Gram stain/culture 1.
Consider CT Scan: In adults with suspected bacterial meningitis and signs of intracranial pathology; however, routine CT before lumbar puncture is debated due to low risk of herniation 2.
Scoring Systems: Bacterial Meningitis Score can help rule out bacterial meningitis in pediatric patients 1.Management
First-Line Treatment: Parenteral antibiotics (e.g., ceftriaxone, ampicillin, vancomycin depending on suspected pathogen) 6.
Timing of Antibiotics: Administration within 30 minutes of triage is ideal but median time observed was 2 hours 6.
Supportive Care: Management of increased intracranial pressure, seizure control, and supportive measures in ICU 3.
Prognostic Indicators: APACHE II, SAPS II, SOFA, and GCS scores can predict mortality in severe cases 3.Special Populations
Pediatrics: Significant decline in incidence, especially in infants <1 year due to vaccinations; focus on early diagnosis and treatment 5.
Comorbidities: Consider potential interactions (e.g., salicylate toxicity complicating meningitis diagnosis and treatment) 7.Key Recommendations
Rapid Antibiotic Administration: Initiate parenteral antibiotics as soon as possible after suspicion of bacterial meningitis (ideally within 30 minutes) to improve outcomes 6 (Evidence: Moderate).
Lumbar Puncture for Diagnosis: Perform lumbar puncture for CSF analysis in suspected cases, considering CT scan selectively based on clinical suspicion of intracranial pathology 2 (Evidence: Moderate).
Use Scoring Systems for Pediatrics: Employ Bacterial Meningitis Score to aid in ruling out bacterial meningitis in pediatric patients 1 (Evidence: Moderate).
Monitor Prognostic Scores: Utilize APACHE II, SAPS II, and GCS scores to assess severity and predict mortality in adult ICU patients with severe bacterial meningitis 3 (Evidence: Moderate).References
1 Clark C. Calculated decisions: Bacterial Meningitis Score for Children. Pediatric emergency medicine practice 2022. link
2 April MD, Long B, Koyfman A. Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?. The Journal of emergency medicine 2017. link
3 Pietraszek-Grzywaczewska I, Bernas S, Łojko P, Piechota A, Piechota M. Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis. Anaesthesiology intensive therapy 2016. link
4 Sheth RD, Pushpanathan C. Neck pain and headache in an afebrile 15-year-old. Seminars in pediatric neurology 1996. link80013-1)
5 Bent JP, Beck RA. Bacterial meningitis in the pediatric population: paradigm shifts and ramifications for otolaryngology-head and neck surgery. International journal of pediatric otorhinolaryngology 1994. link90049-3)
6 Meadow WL, Lantos J, Tanz RR, Mendez D, Unger R, Wallskog P. Ought 'standard care' be the 'standard of care'? A study of the time to administration of antibiotics in children with meningitis. American journal of diseases of children (1960) 1993. link
7 Singer JI. Bacterial meningitis concurrent with salicylism. Pediatric emergency care 1988. link
8 Giampaolo C, Scheld WM, Savory J, Sande MA, Wills MR, Boyd JC. A multivariate approach to prognostication in experimental bacterial meningitis. American journal of clinical pathology 1981. link